Kidnap, Detention & Extortion - Towergate Underwriting

Kidnap, Detention& ExtortionProposal␣Formwww.towergate.co.uk

IMPORTANT INFORMATIONYour insurance contract will be prepared based on the information supplied by you, which is shown on this Proposal. To the best of your knowledge andbelief, you must be satisfied the information is correct.It is important that you let us know about anything that could influence the insurers attitude to your proposal.PLEASE COMPLETE CLEARLY IN BLOCK CAPITALSYour Personal DetailsProposer’s Full Name:(including any subsidiarycompanies to be covered)Address:Postcode:Telephone No:Fax No:E-mail address:Business (please describe fully):Date on which insurance is to commence:/ /Cover Required(please tick)Section A Individual(s) Yes NoSection B Corporate Yes NoSection A. Individual(s)Indemnification for insured losses sustained directly as a result of Kidnap, Extortion, Products Extortion, Detention or Hijack of an Insured Person withinthe insured Territory1. Insured Person(s)Name(s) Date of Birth Occupation Relationship to Proposer2 Proposer’s Country of Residence3 Proposer’s Host Country4 Proposer’s annual income or net worth

5. Annual travel patternInsured Person(s) Territory Business/Pleasure Frequency Average DurationSection B. CorporateIndemnification for insured losses sustained directly as a result of Kidnap, Extortion, Products Extortion, Detention or Hijack of a Covered Person withinthe insured Territory6. Covered Person(s)Name(s) Date of Birth Occupation Country of Residence7. Year Business established?8. Annual turnover of Business?£9. Countries with Business representation?10. Annual travel patternCovered Person(s) Territory Business/Pleasure Frequency Average Duration11. Please provide details of past experience or plans formulated for trips to war zones or politically unstable territories